The <scp>S</scp>ystematic <scp>T</scp>ool to <scp>R</scp>educe <scp>I</scp>nappropriate <scp>P</scp>rescribing (<scp>STRIP</scp>): Combining implicit and explicit prescribing tools to improve appropriate prescribing

Maanen, A. Clara Drenth-van; Leendertse, Anne J.; Jansen, Paul A. F.; Knol, Wilma; Keijsers, Carolina J. P. W.; Meulendijk, Michiel; Marum, Rob J. van

doi:10.1111/jep.12787

Cited by 48 publications

(42 citation statements)

References 26 publications

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“… a Used in 2/8 recommendations; b King's Fund definitions: Appropriate polypharmacy ‐ ‘Prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimized and where the medicines are prescribed according to best evidence’; Problematic polypharmacy – ‘The prescribing of multiple [medicines] inappropriately, or where the intended benefit of the [medicines are] not realized’; ‡Guiding principles for medicines optimization (the Royal Pharmaceutical Society): ‘(i) aim to understand the patient's experience, (ii) evidence‐based choice of medicines, (iii) ensure medicines use is as safe as possible, (iv) make medicines optimization part of routine practice’ . …”

Section: Resultsmentioning

confidence: 99%

“…Regarding the medical history, the documentation of all known diagnoses and conditions as well as existing laboratory test results and medication‐related problems in the electronic medical record was recommended . One guideline recommended the use of a structured questionnaire about medication use, problems, experiences, worries and expectations. The clinical assessment included identification of a wide range of health problems as well as an assessment of physiological status and frailty .…”

Section: Resultsmentioning

confidence: 99%

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Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

et al. 2018

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The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease‐oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow‐up: strategies in care planning, self‐management and medication‐related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self‐management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

et al. 2018

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“…STRIP consists of 5 steps to optimize an individual patient's medication and has proven to be effective in reducing inappropriate prescribing when used by final‐year medical students and in detecting drug‐related problems (mainly PIMs) in patients with an intellectual disability . STRIP is currently considered best practice in the Netherlands …”

Section: Introductionmentioning

confidence: 99%

“…A web‐based application was developed to help physicians carry out a medication review using the STRIP method: the STRIP Assistant. STRIP Assistant helps users to formulate medication recommendations based on STOPP/START criteria version 1 and G‐standaard . G‐standaard is a database comprising all medications registered in the Netherlands, and includes guidelines on established clinical interactions, duplicate medications, contraindications, dosage, and frequency of administration recommendations.…”

Section: Introductionmentioning

confidence: 99%

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The effect of providing prescribing recommendations on appropriate prescribing: A cluster‐randomized controlled trial in older adults in a preoperative setting

Boersma

Huibers

Maanen

et al. 2019

Brit J Clinical Pharma

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Aims The Systematic Tool to Reduce Inappropriate Prescribing is a method to assess patient's medication and has been incorporated into a clinical decision support system: STRIP Assistant. Our aim was to evaluate the effect of recommendations generated using STRIP Assistant on appropriate prescribing and mortality in a preoperative setting. Methods This cluster‐randomized controlled trial was carried out at the preoperative geriatric outpatient clinic. Residents who performed a comprehensive geriatric assessment were randomized to the control group and intervention group in a 1:1 ratio. Visiting patients aged 70 years or older on 5 or more medications were included. Intervention: prescribing recommendations were generated by a physician using STRIP Assistant and given to the resident. Control group residents performed a medication review according to usual care. Primary outcome: number of medication changes made because of potential prescribing omissions (PPOs), potentially inappropriate medications (PIMs), and suboptimal dosages according to the prescribing recommendations. Secondary outcome: 3‐month postoperative mortality. Results 65 intervention and 59 control patients were included, attended by 34 residents. Significantly more medication changes because of PPOs and PIMs were made in the intervention group than in the control group (PPOs 26.2% vs 3.4%, odds ratio 0.04 [95% confidence interval 0.003–0.46] P < .05; PIMS 46.2% vs 15.3% odds ratio 0.14 [95% confidence interval 0.07–0.57] P < .005). There were no differences in dose adjustments or in postoperative mortality. Conclusion Prescribing recommendations generated with the help of STRIP Assistant improved appropriate prescribing in a preoperative geriatric outpatient clinic but did not affect postoperative mortality.

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Polyfarmacie

Keijsers¹,

Marum²

2020

Inleiding in De Gerontologie en Geriatrie

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The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing

Cited by 48 publications

References 26 publications

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

The effect of providing prescribing recommendations on appropriate prescribing: A cluster‐randomized controlled trial in older adults in a preoperative setting

Polyfarmacie

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